Clinical diagnostic value of cerebrospinal fluid lactate in bacterial meningitis of newborn / 中国新生儿科杂志

ABSTRACT

Objective:To study the diagnostic value of cerebrospinal fluid (CSF) lactate level in infants with bacterial meningitis.Methods:From March 2018 to March 2020, infants admitted to the neonatal intensive care unit of our hospital and received lumber puncture were studied retrospectively. According to the diagnostic criteria of neonatal bacterial meningitis, the infants were assigned into bacterial meningitis group and non-bacterial meningitis group. CSF lactic acid, protein and glucose levels of the two groups were compared. JMP10.0 software was used for statistical analysis.Results:A total of 305 infants received lumbar puncture for CSF, 2 cases of intraventricular hemorrhage (grade Ⅲ~Ⅳ), 1 case of viral encephalitis and 1 case of neurosyphilis were excluded. 63 cases were in the bacterial meningitis group and 238 cases were in the non-bacterial meningitis group. The CSF cultures were positive in 5 cases and the blood cultures were all negative. The median levels of CSF lactic acid, protein and CSF lactic acid/CSF glucose in the bacterial meningitis group were 1.41 mmol/L, 2.1 g/L and 0.60, both significantly higher than the non-bacterial meningitis group (1.11 mmol/L, 1.2 g/L and 0.40) ( P<0.05). The median CSF glucose level in the bacterial meningitis group was 2.3 mmol/L, significantly lower than the non-bacterial meningitis group (2.5 mmol/L). When the cut-off value of CSF lactic acid was 1.47 mmol/L, the sensitivity and specificity of the diagnosis of bacterial meningitis were 49.2% and 79.9%. When the cut-off value of CSF protein was 2.26 g/L, the sensitivity and specificity of the diagnosis of bacterial meningitis were 49.2% and 91.2%. When the cut-off value of CSF lactic acid/CSF glucose ratio was 0.48, the sensitivity and specificity of the diagnosis of bacterial meningitis were 73.0% and 62.4%. Conclusions:CSF lactic acid is helpful in the diagnosis of neonatal bacterial meningitis. The combination of CSF protein and CSF lactic acid/CSF glucose ratio can improve the specificity and sensitivity of the diagnosis.